Substantially impaired quality of life was shown in patients with photoaggravated atopic dermatitis, with phototesting cited as an effective diagnostic approach in promoting personalized care.
Diagnostic confirmation of photoaggravated atopic dermatitis (PAD) via phototesting may lead to improved clinical outcomes among patients, who experience a significant quality of life (QOL) burden from PAD.
Published recently in JAMA Dermatology, researchers sought to investigate the clinical and photobiological characteristics of PAD, a poorly understood subtype of AD that is exacerbated by ultraviolet radiation (UVR). An estimated 1.4% to 16% of patients with AD are affected by this disease subtype, although available studies focusing on the condition are scarce.
A case series study of cross-sectional data collected from 120 consecutive patients diagnosed with PAD from January 2015 to October 2019 at a tertiary center referral unit for photobiology was conducted to evaluate the demographic and clinical features of PAD.
A detailed standardized photoinvestigation was also performed, including analyses of monochromator phototesting responses to UVR and visible light (VIS), to assess wavelength sensitivity, erythemal thresholds, and responses to solar-simulated radiation in patients with a range of skin phototypes (SPTs).
“On the basis of clinical suspicion that patients with darker skin had differing characteristics from those with lighter skin, a subgroup analysis was performed for SPTs I to IV and SPTs V to VI. Subgroup comparisons used unpaired t tests or nonparametric equivalents as appropriate,” explained the study authors. “Multiple linear or logistic regression explored associations between demographic and clinical variables.”
A total of 869 patients underwent photoinvestigation, of whom 120 (14%) were diagnosed with PAD (median age, 45 years; IQR, 31-61 years; range, 5-83 years; SPTs I-VI; 58% female; 104 were adults [87%]).
All participants had a history of AD, and a majority of adult patients (60%) presented with sunlight-provoked or photodistributed eczema, with a median age at photosensitivity onset of 37 years (range, 1-72 years). Delays in diagnosis were common, with median age at diagnosis 8 years later than median age at photosensitivity onset.
Overall, 80 of 103 adults (78%) experienced very or extremely impaired QOL, with past-year Dermatology Life Quality Index (DLQI) scores greater than 10. Vitamin D (25-hydroxyvitamin D) insufficiency or deficiency (< 20 ng/mL) was also found among 82 of 119 (69%) patients.
“The multiple linear regression model evaluating associations between past-week DLQI score and other variables showed that provocation through window glass and age at photosensitivity onset were significantly associated with past-week DLQI score,” said researchers.
Findings further showed that broadband UV radiation provocation test results were positive for 112 patients (93%), narrowband phototest findings were abnormal for 23%, and photopatch test reactions were positive for 15%. Regarding those with abnormal monochromator phototest, sensitivity occurred to UV-A, UV-B, and/or visible light, and UV-A of 350 ± 10 nm was the most prevalent wavelength.
Compared with patients with lighter skin (SPT I to IV, n = 89), those with darker skin (SPTs V to VI, n = 31) were younger at photosensitivity onset (median age, 24 years [IQR, 15-37 years] vs 40 years [IQR, 25-55 years]; P = .003), were more likely to be female (23 [74%] vs 46 [52%]; P = .03), and had a lower vitamin D status and a higher frequency of abnormal monochromator phototest findings.
“The study’s findings suggest that improved knowledge of PAD presentation, demographic aspects, and photoinvestigation can assist patient diagnosis and treatment and that more attention should be given to this condition,” concluded the study authors.
Reference
Rutter KJ, Farrar MD, Marjanovic EJ, Rhodes LE. Clinicophotobiological characterization of photoaggravated atopic dermatitis. JAMA Dermatol. Published online July 27, 2022. doi:10.1001/jamadermatol.2022.2823
Real-World Data Show Sotorasib Effective for NSCLC With KRAS Mutation
May 18th 2024Data from real-world and clinical-trial settings on frontline monotherapy treatment with the KRAS inhibitor sotorasib both show similar progression-free survivals and a high likelihood that the treatment’s efficacy is not affected with dose reduction.
Read More
Health Equity and Access Weekly Roundup: May 18, 2024
May 18th 2024The US Senate hosted a panel addressing physician and health care shortages and efforts to increase minority representation in the medical field. An expert discussed initiatives to prevent senior homelessness. Advocates called for the repeal of the Comstock Act. Regulatory reforms are called for to improve rural cancer patients' access to pharmacies. Research reveals the impact of denials on patient access to immunology treatments.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Study Highlights Significant Increases in Utilization, Spending on DMD Drugs in Medicaid
May 17th 2024The findings add to recent research on the growing utilization, expenditure, and prices of Duchenne muscular dystrophy (DMD) therapies in the current landscape, an area health care policy could potentially address.
Read More